Autism in Girls–“Hiding in Plain Sight”

According to the Centers for Disease Control, four boys to every one girl are diagnosed as having an autism spectrum disorder (ASD), a neurodevelopmental disorder which affects 1 in 59 children in the United States alone. Do symptoms of autism present differently in boys compared to girls and does this impact rates of diagnosis? A recent article from the Child Mind Institute explored Why Many Autistic Girls are Overlooked and highlighted critical reflection points.

A Male Model for Autism

The key signs of autism include challenges in social-communication and social interaction as well as restricted interests/repetitive behaviors. Even though the same symptoms may appear in both girls and boys, some researchers believe that the model for an autism diagnosis has been primarily a male model, which could potentially impact diagnosis and treatment for girls. According to Dr. Susan Epstein, a clinical neuropsychologist, “the model we have for a classic autism diagnosis has really turned out to be a male model. That’s not to say that girls don’t ever fit it, but girls tend to have a quieter presentation…” As such, gender stereotypes may get in the way of recognition. “So where the boys are looking at train schedules, girls might have excessive interest in horses or unicorns, which is not unexpected for girls,” Dr. Epstein states. “But the level of the interest might be missed and the level of oddity can be a little more damped down. It’s not quite as obvious to an untrained eye.”

Symptoms of Autism in Girls

Although the criteria for diagnosing autism is not different for boys or girls, autism may present differently in girls and such symptoms may be more subtle. Dr. Wendy Moyal, a child and adolescent psychiatrist, notes “If girls are socially interested but odd, which is the case with the majority of these girls, I think people give them a pass.”

How Girls Differ From Boys with Autism

A few ways in which symptoms of autism may present differently in boys and girls include:

Boys tend to have very repetitive and limited areas of play while girls are less repetitive with broader areas of play.

Girls with autism are more likely than boys to also suffer from anxiety and/or depression.

Girls with autism are less likely than boys to behave aggressively and more likely to be passive or withdrawn.

While boys’ social communication issues become challenging very early in their lives, girls may be able to manage the social demands of early childhood but run into difficulties as they enter early adolescence.

What is the Cost of “Hiding in Plain Sight”?

There are substantial risks for not accurately diagnosing girls who in fact have autism but are able to “pass” as neurotypical. First, such girls miss the opportunity of early intervention and support in school through an Individual Education Plan (IEP). Additionally, they may be misdiagnosed (e.g., with ADHD) and/or subsequently develop mental health concerns. Specifically, girls with ASD who are not accurately diagnosed are at more risk for developing anxiety and depression. Moreover, navigating adolescence for girls with ASD becomes even more complicated given their social-communication challenges and there are greater safety risks.